In a new editorial, 2 prominent physicians argue the incoming class of medical students ought to have their first year of medical school replaced with a year of public health service.
The coronavirus disease 2019 (COVID-19) pandemic has dramatically reshaped the economy, health care, and the education system. But in order to solve the problem, a pair of prominent physicians say a radical restructuring of another institution—medical school—might prove necessary.
In an editorial published this month in The Journal of the American Medical Association, the journal’s editor-in-chief, Howard Bauchner, MD, and Joshua Sharfstein, MD, a professor at the Bloomberg School of Public Health at Johns Hopkins University, argue incoming medical school students should have their first year of medical school suspended and replaced with the opportunity to join a national service program for public health.
“Such a bold approach may be needed to ensure that the US has an adequate response to the next wave of disease and does not enter a prolonged depression that will further adversely affect the health of its citizens,” they write.
The concept is based in part on concerns that, even if the pandemic is brought to submission in the coming months, it could return again before a vaccine or therapy is developed.
Bauchner and Sharfstein’s plan would involve the roughly 20,000 incoming medical students reporting for online classes in July, where they would study infectious disease epidemiology and control, as well as outbreak response.
After a month of such training, the students would be deployed to state and local public health agencies to support efforts to test, trace, track, and contain the virus. Under the plan, the federal government would pick up the tab and pay the student-workers a salary. Such a move would be meaningful and economically beneficial, they write, in part because many local governments don’t have the capacity to undertake the kinds of steps necessary to curtail outbreaks on their own.
“Today, localities have few resources available to stop community spread other than closing businesses, curtailing large gatherings, and schooling at home,” the authors note.
“As soon as the novel coronavirus arrives in a community, many are at risk for falling ill, straining the health care system, causing fear, and devastating the economy.”
Medical students could be involved in disease surveillance efforts and assist local governments in implementing protection measures aimed at keeping high-risk patients safe. They could also staff call centers to help give guidance to people who may have come into contact with an infected person. The authors note that many medical students have already taken on similar roles of their own initiative. Formalizing the process would help give a major boost to the nation’s public health infrastructure while also giving meaningful work experience to future doctors, the authors say.
Bauchner and Sharfstein concede that such an effort would have downstream effects. For one, it would create a lack of students available for internships in 2025, and then a glut of students applying for residencies the following year. However, the authors argue that state regulators and medical schools would have sufficient time to make changes to ease the impacts, such as allowing exceptional students to graduate early.
The program would also be costly, though Bauchner and Sharstein say it would also have economic benefits, and it would likely result in a more robust public health workforce than if state and local governments are forced to recruit and train their own staffs.
“The logistics of such a program are substantial, and time is short, but without such an effort, the US could well find itself largely shut down this fall,” they write.